Aleppo: Health and nutrition for threatened children

Children in the city of Aleppo are growing up in one of the most dangerous cities in the world. Health workers in Aleppo are at the front lines of saving lives. The announcement of the recent reinstatement cessation of hostilities offers hope that the violence will be reduced, that children can be given a chance to live without constant fear, and that they will be able to live in  peace and safety.

It’s hard to think of a “normal” day in Aleppo. How can we live normally during this ruinous war? But we do continue to live. Most days we forget to look at the clock and forget we have to go home.

I studied medicine here and the city became my home. But like most Syrians, I’ve moved many times in the past five years.

I had a cozy house before the war, but I had to flee it when my neighbourhood turned into a conflict zone. I came back at the end of 2013 and the city was almost unrecognizable. I lost my house and private clinic. I was separated from family and moved several times between hotels and other houses. Last year, I settled in a house in a relatively quiet area but I had to leave it again as fighting escalated recently. I am temporarily staying with friends.

I love this city, although I miss the way it used to be. I miss walking alone after midnight and feeling completely safe. I miss the times I used to walk for hours through the beautiful streets with my friends.

A health worker vaccinates a child.
UNICEF partners in eastern Aleppo established mobile teams to deliver life-saving vaccinations during the second round of the nationwide routine immunisation campaign in July this year. Mobile teams walked door-to-door to reach out to families to make sure every child received life-saving immunisation.

I miss the Old City and the Citadel. I used to feel that its stones spoke, telling people about how great this city is. Aleppo was the city that never slept.

As a nutritionist working with UNICEF, I get to touch the lives of many children. Every day, I think about the children I meet.

I met Ali when he was six months old and suffering from severe acute malnutrition after being trapped in an area under siege. UNICEF helped evacuate Ali. We treated him for eight months and his health improved slowly, day by day. The smile on his previously tearful, exhausted face was the greatest reward for me.

But Ali’s story’s ended tragically. He was killed when he was only two years old, when the neighborhood his family took shelter in was shelled. I’ll never forget Ali’s smile – I see Ali every time I see a child his age.

I like to start my mornings early, to prepare myself psychologically and physically for the day ahead. I drive my car around the city, watching people on the streets, wondering what their stories might be. I hold my most important meetings early in the morning when the city is the quietest. Then all the action starts: field visits, conducting assessments, meeting partners, reporting on what needs to be done and most importantly reaching children with the assistance they need.

Every day in Aleppo is a challenge, increasingly since the fighting intensified. Our city is divided between eastern and western parts, moving freely between the two parts isn’t always possible. This division makes it that much harder to reach children.

We have not been able to reach the eastern part of the city since the start of this year. UNICEF works to support partners in the east who deliver pediatric and maternal healthcare, including nutritional screening and prevention, treatment of malnutrition and vaccination. Even though I cannot cross to the eastern neighbourhoods, I stay in constant contact with partners. We have been able to support partners with pre-stocked emergency supplies, including nutrition treatments. But we need unrestricted access to bring supplies and support health workers who are under immense pressure.

Fighting and violence has affected children and families all over the city. Similar nutritional problems are being seen in western parts of the city, especially among the 35,000 people displaced by recent fighting. Some of these families live in relief centres set up in schools and mosques. Others sleep in parks or on the streets. To reach these families, we quickly set up nine mobile clinics with our partners. I visit these children regularly and treat children with diarrhoea. A few children had Hepatitis A, which is very worrying. The risk of water-borne diseases has increased since the city’s water supply was cut off in early August. A mass outbreak would be catastrophic for children. UNICEF’s massive emergency water response aims to prevent this.

But health facilities in the city are beyond stretched. Only one third of the city’s health facilities function, due to damage and destruction. Doctors and health workers are working under extremely dangerous conditions, and many have been killed and injured. I have the deepest respect and admiration for every single doctor in Aleppo. Children and families depend on them. In August, I visited an injured doctor, a colleague from one of our partner organisations, in hospital. He had metal fragments lodged in his face, after his mobile clinic was hit. He looked at me and said, “No matter what, I do not want to leave my city”.

Every child in Aleppo has a story. I often think about Ahmad who is 11. Ahmad has cancer and stays in the hospital with his mother. The fighting has blocked the road back to his home.

Ahmad is no more than thin skin on tiny bones. When we visited, he was very curious about our camera, but was too weak to lift it in his shaking hands. When he dropped it, the look on his face was just heartbreaking. I gave him my mobile phone instead encouraging him that it was much higher tech. I love the photo he took of me and his proud smile when he gave the phone back.

To work in Aleppo is an act of love and belief. You do not stay in the one of the most dangerous cities in the world unless you love the place, the people, and the children. You don’t stay unless you truly believe in humanity and feel an obligation to make the world a better place. Maybe I’m a dreamer but I believe we can make a difference.

Dr. Esraa Al-Khalaf, UNICEF Nutritionist, Aleppo, holds a PhD in Pediatric Medicine. She joined UNICEF in 2013 as a health and nutrition facilitator in Aleppo, where she has been living since 1998 when she started higher education. Before the crisis, Esraa worked in public and private hospitals in Aleppo, she had her own pediatric clinic. She also taught at the Aleppo University Hospital. Esraa loves children, and that is why she dedicated her life to support children in any way possible.  



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